Provider Demographics
NPI:1659318244
Name:CHANG, DUANE A (OD)
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:A
Last Name:CHANG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-050 FARRINGTON HWY
Mailing Address - Street 2:SUITE B1-1
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-1841
Mailing Address - Country:US
Mailing Address - Phone:808-677-1544
Mailing Address - Fax:808-671-3538
Practice Address - Street 1:94-050 FARRINGTON HWY
Practice Address - Street 2:SUITE B1-1
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-1841
Practice Address - Country:US
Practice Address - Phone:808-677-1544
Practice Address - Fax:808-671-3538
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI267152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI04135901Medicaid
HI04135902Medicaid
HI04135902Medicaid
HIH0000PGBKPMedicare PIN
HIH0000PGBKRMedicare PIN